Taking first steps in your chiropractic career
I graduated from chiropractic school in 2003, and I saw my first patient in my own clinic in March 2004—three months after graduating.
That is how long it took me to get my board scores, pass my jurisprudence exam, and paint the walls. In fact, I signed my lease in the fall before I graduated. This was definitely not a good plan. I was underfunded—the No. 1 cause of business failure today.
I only had some savings, a small loan from a family member, and savings bonds my grandma gave me. I hated getting savings bonds for Christmas, but they later helped me buy used chiropractic equipment.
Well, things worked out well since then. In 14 some years I went from a little 700-square-foot space to one with 6000 square feet, along with two chiropractors as well as two physical therapists, an acupuncturist, and an in-office medical doctor working for me.
It’s been a great journey, but while I made it work and had a lot of help along the way, times have changed, student loans have gone up, and insurance and regulatory issues in running a practice make it much more difficult today than in 2004.
The associate route
In the current landscape, it is more difficult to start a practice from scratch—especially if you have student loans. Recently, I was trying to help a new graduate open a clinic right out of school. Due to his large student loan balance, the banks wouldn’t even lend him $30,000 to start. Eventually, he had to get a job.
It is hard to get startup capital and even if you can, the minefield of hazards in opening is dense. You could get through it (especially with some help), but why not learn on someone else’s dime? It might be best to get an associate position first. Find one in a practice style similar to yours.
Work for someone whom you would like to emulate. And look for an associate position that pays you a living wage and has an upside such as a bonus structure or profit sharing. Those jobs are out there. My associates commonly make six-figure salaries with a bonus plan and other perks.
Learning the ropes
Most new docs should associate for a minimum of two years. It takes that long to learn the ropes of treating patients, filling out forms, etc. If you are interested in starting your own practice one day, learn the other end of the business in someone else’s practice.
Learn the billing, front desk, and forms used, and go to seminars and learn from a mentor. See what you like and don’t like about practice.
Learn and earn, all the while figuring out our complicated health care system. If you like it, stick around, but no matter what, give it at least two years.
Going your own way
Running your own practice isn’t for everyone, but if you want to make the leap, here is my advice: Currently, chiropractic practices are selling cheap. Most businesses can sell for a multiple of gross income. Let’s say a business is collecting $1 million a year. In many industries, to buy that business you might pay two or three times that amount. But not a chiropractic practice.
There are different computing methods out there, but one metric is eight months’ collections. Thus if you bill $1 million a year, you can sell the practice for $650,000 or so. And the average office collects less than that.
If you purchase a smaller practice, you’ll be paying less than the buildout and equipment would cost. For example, a small clinic collecting $100,000 a year might sell for $75,000 or even less. This would include all the equipment, etc., which would probably cost more than $100,000 to buy new. Then you get the patients who stay with the practice and the old files you can call.
Caution: Don’t open too close to where you did your associateship. Some DCs do this to try to steal patients. Don’t do it; it’s bad karma. It always ends poorly and usually the senior doc has more funds and better lawyers than you. There are plenty of patients out there.
There are 100 ways to start your career. I would not recommend the way I did it, but any way you choose to start your chiropractic career, work hard, be patient, keep learning, and give it your all.
James R. Fedich, DC, is a practicing chiropractor in Northwest New Jersey. He is also the published author of Secrets of a Million Dollar Practice and host of a top-rated podcast, Path to Success with Dr J. He can be contacted at firstname.lastname@example.org, or through drjamesfedich.com.